Original Research
Cardiac Imaging
Prognostic Value and Risk Continuum of Noninvasive Fractional Flow Reserve Derived from Coronary CT Angiography
Abdul Rahman Ihdayhid, Bjarne L. Norgaard, Sara Gaur, Jonathan Leipsic, Nitesh Nerlekar, Kazuhiro Osawa, Toru Miyoshi, Jesper M. Jensen, Takeshi Kimura, Hiroki Shiomi, … Show all Authors
Author Affiliations
From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia 3168 (A.R.I., N.N., S.K.S., B.S.K.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G., J.M.J., H.E.B.); Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan (K.O., T.M.); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (T.K., H.S.); Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (A.E., S.J.); West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.G.O.); and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany (S.A.).
Address correspondence to B.S.K. (e-mail: Brian.Ko@monash.edu).
Published Online:Jun 11 2019https://doi.org/10.1148/radiol.2019182264
See editorial byCarole Dennie
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Abstract
FFRCT of 0.8 or less is a predictor of long-term clinical outcomes and is superior to clinically significant stenosis on coronary CT angiograms. A normal FFRCT is associated with favorable long-term prognosis and the numeric value of FFRCT also demonstrates an independent and inversely related risk continuum.
Background
Coronary CT angiography with noninvasive fractional flow reserve (FFR) predicts lesion-specific ischemia when compared with invasive FFR. The longer term prognostic value of CT-derived FFR (FFRCT) is unknown.
Purpose
To determine the prognostic value of FFRCT when compared with coronary CT angiography and describe the relationship of the numeric value of FFRCT with outcomes.
Materials and Methods
This prospective subanalysis of the NXT study (Clinicaltrials.gov: NCT01757678) evaluated participants suspected of having stable coronary artery disease who were referred for invasive angiography and who underwent FFR, coronary CT angiography, and FFRCT. The incidence of the composite primary end point of death, myocardial infarction, and any revascularization and the composite secondary end point of major adverse cardiac events (MACE: cardiac death, myocardial infarction, unplanned revascularization) were compared for an FFRCT of 0.8 or less versus stenosis of 50% or greater on coronary CT angiograms, with treating physicians blinded to the FFRCT result.
Results
Long-term outcomes were obtained in 206 individuals (age, 64 years ± 9.5), including 64% men. At median follow-up of 4.7 years, there were no cardiac deaths or myocardial infarctions in participants with normal FFRCT. The incidence of the primary end point was more frequent in participants with positive FFRCT compared with clinically significant stenosis at coronary CT angiography (73.4% [80 of 109] vs 48.7% [91 of 187], respectively; P < .001), with the majority of outcomes being planned revascularization. Corresponding hazard ratios (HRs) were 9.2 (95% confidence interval [CI]: 5.1, 17; P < .001) for FFRCT and 5.9 (95% CI: 1.5, 24; P = .01) for coronary CT angiography. FFRCT was a superior predictor compared with coronary CT angiography for primary end point (C-index FFRCT, 0.76 vs coronary CT angiography, 0.54; P < .001) and MACE (FFRCT, 0.71 vs coronary CT angiography, 0.52; P = .001). Frequency of MACE was higher in participants with positive FFRCT compared with coronary CT angiography (15.6% [17 of 109] vs 10.2% [19 of 187], respectively; P = .02), driven by unplanned revascularization. MACE HR was 5.5 (95% CI: 1.6, 19; P = .006) for FFRCT and 2.0 (95% CI: 0.3, 14; P = .46) for coronary CT angiography. Each 0.05-unit FFRCT reduction was independently associated with greater incidence of primary end point (HR, 1.7; 95% CI: 1.4, 1.9; P < .001) and MACE (HR, 1.4; 95% CI: 1.1, 1.8; P < .001).
Conclusion
In stable patients referred for invasive angiography, a CT-derived fractional flow reserve (FFRCT) value of 0.8 or less was a predictor of long-term outcomes driven by planned and unplanned revascularization and was superior to clinically significant stenosis on coronary CT angiograms. Additionally, the numeric value of FFRCT was an independent predictor of outcomes.
© RSNA, 2019
Online supplemental material is available for this article.
See also the editorial by Dennie and Rubens in this issue.
Cardiac Imaging
Prognostic Value and Risk Continuum of Noninvasive Fractional Flow Reserve Derived from Coronary CT Angiography
Abdul Rahman Ihdayhid, Bjarne L. Norgaard, Sara Gaur, Jonathan Leipsic, Nitesh Nerlekar, Kazuhiro Osawa, Toru Miyoshi, Jesper M. Jensen, Takeshi Kimura, Hiroki Shiomi, … Show all Authors
Author Affiliations
From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria, Australia 3168 (A.R.I., N.N., S.K.S., B.S.K.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (B.L.N., S.G., J.M.J., H.E.B.); Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan (K.O., T.M.); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (T.K., H.S.); Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (A.E., S.J.); West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.G.O.); and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany (S.A.).
Address correspondence to B.S.K. (e-mail: Brian.Ko@monash.edu).
Published Online:Jun 11 2019https://doi.org/10.1148/radiol.2019182264
See editorial byCarole Dennie
Sections
Full text
Tools
Share
Abstract
FFRCT of 0.8 or less is a predictor of long-term clinical outcomes and is superior to clinically significant stenosis on coronary CT angiograms. A normal FFRCT is associated with favorable long-term prognosis and the numeric value of FFRCT also demonstrates an independent and inversely related risk continuum.
Background
Coronary CT angiography with noninvasive fractional flow reserve (FFR) predicts lesion-specific ischemia when compared with invasive FFR. The longer term prognostic value of CT-derived FFR (FFRCT) is unknown.
Purpose
To determine the prognostic value of FFRCT when compared with coronary CT angiography and describe the relationship of the numeric value of FFRCT with outcomes.
Materials and Methods
This prospective subanalysis of the NXT study (Clinicaltrials.gov: NCT01757678) evaluated participants suspected of having stable coronary artery disease who were referred for invasive angiography and who underwent FFR, coronary CT angiography, and FFRCT. The incidence of the composite primary end point of death, myocardial infarction, and any revascularization and the composite secondary end point of major adverse cardiac events (MACE: cardiac death, myocardial infarction, unplanned revascularization) were compared for an FFRCT of 0.8 or less versus stenosis of 50% or greater on coronary CT angiograms, with treating physicians blinded to the FFRCT result.
Results
Long-term outcomes were obtained in 206 individuals (age, 64 years ± 9.5), including 64% men. At median follow-up of 4.7 years, there were no cardiac deaths or myocardial infarctions in participants with normal FFRCT. The incidence of the primary end point was more frequent in participants with positive FFRCT compared with clinically significant stenosis at coronary CT angiography (73.4% [80 of 109] vs 48.7% [91 of 187], respectively; P < .001), with the majority of outcomes being planned revascularization. Corresponding hazard ratios (HRs) were 9.2 (95% confidence interval [CI]: 5.1, 17; P < .001) for FFRCT and 5.9 (95% CI: 1.5, 24; P = .01) for coronary CT angiography. FFRCT was a superior predictor compared with coronary CT angiography for primary end point (C-index FFRCT, 0.76 vs coronary CT angiography, 0.54; P < .001) and MACE (FFRCT, 0.71 vs coronary CT angiography, 0.52; P = .001). Frequency of MACE was higher in participants with positive FFRCT compared with coronary CT angiography (15.6% [17 of 109] vs 10.2% [19 of 187], respectively; P = .02), driven by unplanned revascularization. MACE HR was 5.5 (95% CI: 1.6, 19; P = .006) for FFRCT and 2.0 (95% CI: 0.3, 14; P = .46) for coronary CT angiography. Each 0.05-unit FFRCT reduction was independently associated with greater incidence of primary end point (HR, 1.7; 95% CI: 1.4, 1.9; P < .001) and MACE (HR, 1.4; 95% CI: 1.1, 1.8; P < .001).
Conclusion
In stable patients referred for invasive angiography, a CT-derived fractional flow reserve (FFRCT) value of 0.8 or less was a predictor of long-term outcomes driven by planned and unplanned revascularization and was superior to clinically significant stenosis on coronary CT angiograms. Additionally, the numeric value of FFRCT was an independent predictor of outcomes.
© RSNA, 2019
Online supplemental material is available for this article.
See also the editorial by Dennie and Rubens in this issue.
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